• There is no cost to join the discount card program.
• You will receive the ID card within 1 week after WPDP receives your enrollment form.
• Enrolling in Medicare Part D or other prescription drug coverage will not disqualify you from enrolling in this program.
• For more information on the program, please see our Frequently Asked Questions or call Moda Health customer service toll-free at 800-913-4146.

To receive your Prescription Drug Discount Card, please complete the information below.
If you have not received an ID card within 5 business days call Moda Health customer service at 800-913-4146, please do not re-enroll.

For existing members who need to update current information, or request a new ID card, please call Moda Health customer service at 800-913-4311.

First Name
Middle Initial
Last Name
Date of Birth
Gender	Male  Female
Street Address
City
State
Zip
Phone Number
To receive communication via email please enter your email address. To receive communication via email, please enter your email address. If you do not enter an email address, you will receive communications by mail. Please be assured your email is confidential and will never be sold or rented. For questions, please contact Moda Health customer service at 800-913-4146.
Where did you hear about this program?	AARP	Employer
	Craigslist	Pharmacy
	Newspaper	Insurance Company
	Faith-based organization	Hospital/Clinic
	Radio	Senior Center
	School or college	State Agency
	Social Services	Other website
	Television	Tri-Met
	Friends/Family	Unemployment Office
	WPDP website	Other
	Submit